title: Modified constraint-induced movement therapy versus intensive bimanual training for children with hemiplegia - a randomized controlled trial.
abstract: OBJECTIVE
  To clarify whether modified constraint-induced movement therapy provides greater improvement than intensive bimanual training both for motor functions and spontaneous use of the paretic arm and hand in everyday life activities.
  
  
  METHODS
  Randomized controlled, single-blind trial.
  
  
  METHODS
  Inpatient paediatric rehabilitation clinic.
  
  
  METHODS
  Forty-seven children with unilateral cerebral palsy or other non-progressive hemiplegia (aged 3.3-11.4 years) were randomly assigned to either a modified constraint-induced movement programme (kid-CIMT) or intensive bimanual training.
  
  
  METHODS
  Patients in the kid-CIMT group received 60 hours of unilateral constraint-induced and 20 hours of bimanual training over four weeks. Patients in the bimanual treatment group received 80 hours of bimanual training over four weeks.
  
  
  METHODS
  Melbourne Assessment of Unilateral Upper Limb Function and Assisting Hand Assessment.
  
  
  RESULTS
  Modified constraint-induced therapy provided a significantly better outcome for isolated motor functions of the paretic arm than bimanual training (gain in Melbourne Assessment, percent score: 6.6 vs. 2.3, P= 0.033). Regarding spontaneous use both methods led to similar improvement (gain in Assisting Hand Assessment, percent score: 6.2 vs. 4.6, P= 0.579). More-disabled children showed greater improvement than less-disabled ones (correlation with Assisting Hand Assessment pretreatment score r = -0.40). Age did not affect treatment outcome.
  
  
  CONCLUSIONS
  Modified constraint-induced movement therapy can improve isolated functions of the hemiplegic arm better than intensive bimanual training, but regarding spontaneous hand use in everyday life both methods lead to similar improvement. Improvements are generally greater in more impaired children. Age does not affect outcome.
authors.affiliation: Neurological Rehabilitation Centre for Children and Adolescents, Klinik Bavaria Kreischa, Kreischa/Dresden, Germany. w.deppe@t-online.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Deppe
authors.forename: Kerstin
authors.initials: K
authors.lastname: Thuemmler
authors.forename: Judith
authors.initials: J
authors.lastname: Fleischer
authors.forename: Claudia
authors.initials: C
authors.lastname: Berger
authors.forename: Susanne
authors.initials: S
authors.lastname: Meyer
authors.forename: Baerbel
authors.initials: B
authors.lastname: Wiedemann
mesh_terms: D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D026241:Exercise Movement Techniques / Q000379:methods*; D005260:Female; D006429:Hemiplegia / Q000534:rehabilitation*; D006801:Humans; D007297:Inpatients; D008297:Male; D012047:Rehabilitation Centers; D012149:Restraint, Physical / Q000379:methods*; D012720:Severity of Illness Index